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OBESE BINGE EATERS.
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Development of effective interventions.... More...
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Paper Abstract:
Development of effective interventions. Scope of binge eating problem. Physiological and psychological condition. Discusses the most useful strategies to assist obese female binge-eaters in controlling their binging behaviors, and losing weight as part of a lifestyle change. Use of behavioral interventions and pharmacological therapy. Need for psychotherapists to be proactive.
Paper Introduction:
Effective Interventions for Obese Binge Eaters
Introduction
The estimates of binge eating among obese individuals range from 20 to 50 percent, depending upon the criteria used and the study population (Goodrick, Poston, Kimball, Reeves, & Foreyt, 1998). For obese individuals, binge eating is often found to be comorbid with a wide range and variety of other physiological and psychological conditions and disorders (Wadden, Foster, & Letizia, 1992). For medical caregivers, developing effective intervention strategies to assist patients in eliminating binge eating, reduce and then maintain weight loss, and cope with the comorbid conditions they may experience while developing healthy
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A 26-week long programwas implemented at 14 national clinics. Inboth groups, reported binge eating declined and no relationship wasobserved between binge eating, weight loss, or attrition. Professional Psychology: Research and Practice, 2 (1), 62-64.Goodrick, G.K., Poston, W.S.C., Kimball, K.T., Reeves, R.S., & Foreyt, J.P. Results suggest that neither intervention wasparticularly successful in producing short-term or long-term weight loss,but both were successful in reducing and then sustaining reducement ofbinge eating behaviors. Results revealed that these caregivers did recommend suchtherapies, but that they did so less than is desirable and were lessknowledgeable regarding such interventions than is needed. For obeseindividuals, binge eating is often found to be comorbid with a wide rangeand variety of other physiological and psychological conditions anddisorders (Wadden, Foster, & Letizia, 1992). In other words,the researchers concluded that it is important for psychotherapists to takea more proactive role in this area than is the case. Journal of Consulting and Clinical Psychology, 16(5), 8 8-811.Wadden, T.A., Foster, G.D., & Letizia, K.A. Wadden, Foster and Letizia (1992) also examined long-term behavioraltherapy and a very low calorie diet (VLCD) in a sample of 235 female obesebinge eaters, episodic overeaters, and non-bingers. ReferencesBurks, R., & Keeley, S. Diet treatmentsubjects received a BDD reinforced with behavioral strategies. Weekly group behavioral therapysessions were included. Three conditions were employed in the study: CBT alone,Tenuate + CBT, and CBT + placebo. However, more research is clearly needed to provide acomprehensive answer to the research question posed above. Bothgroups did reduce their binge eating scale scores significantly more thansubjects on the wait-list. Weight lossstrategies and interventions for obese women that include either VLCD orBDD are both effective in fostering weight loss, but attrition among obesewomen (i.e., regain of weight) is commonplace. Both groups received treatment in weekly sessions ofmultiple subjects for six months followed by 26 bi-weekly maintenancemeetings. Journal of Consulting and Clinical Psychology, 62(1), 165-171. End-of-treatment weightlosses for the three conditions did not differ significantly and nosignificant differences were observed among conditions in weight re-gain inthe year following treatment. By year 1 after terminationof the intervention, none of the study groups showed further significantweight gain. Effective Interventions for Obese Binge EatersIntroduction The estimates of binge eating among obese individuals range from 2 to 5 percent, depending upon the criteria used and the study population(Goodrick, Poston, Kimball, Reeves, & Foreyt, 1998). These researcherssuggested that psychotherapists, who often see patients for whom overweightor obesity is one of several "presenting problems," may be lessknowledgeable than is desirable regarding the ways in which diet andexercise can be used in a therapeutic milieu to encourage healthy lifestylechanges and choices. Wadden, et al (1992) found no significant differences amongconditions in the number of subjects who completed treatment. (1988). (1989). Exercise and diet therapy: Psychotherapists' beliefs and practices. Nondiettreatment consisted of therapy designed to help participants eliminatedieting cycles. The final study reviewed herein was conducted by Goodrick, et al(1998). The CBT + Tenuate group did better thanother groups in the latter half of the 2 -week intervention, but at six-month follow-up showed greatest weight regain. The VLCD subjects lostsignificantly more weight than the BDD subjects at all periods through week26, at which time mean losses were 21.5 and 11.86 kg respectively.However, Wadden, et al (1994) also reported that VLCD regained weightduring the next 26 weeks of weekly behavioral therapy and during a 26-weekweight maintenance program that provided biweekly support meetings. Wadden, et al (1994) revisited this issue in a one-year behavioraltreatment of obesity, comparing the relative efficacy of moderate orbalanced deficit diet (BDD) with a VLCD. First, Burks and Keeley (1989) examined the beliefs ofpsychotherapists regarding the efficacy of exercise and diet therapy forobese and overweight patients, regardless of gender. For medical caregivers,developing effective intervention strategies to assist patients ineliminating binge eating, reduce and then maintain weight loss, and copewith the comorbid conditions they may experience while developing healthylifestyles and diets is an important task. Women appear to be particularly responsive to cognitive-behavioraltherapies associated with developing healthier dietary choices and eatingpatterns. One-year behavioral treatment of obesity: Comparison of moderate and severe caloric restriction and the effects of weight maintenance therapy. They hypothesized that a combination of cognitive-behavioraltherapy (CBT) and Tenuate would result in greater initial weight loss andsustained loss. The study evaluated the effectiveness of nondieting versus dietingtreatments for overweight women who identified themselves as binge eaters.A total of 219 participants were randomly assigned to either diettreatment, nondiet treatment, or wait-list control. Combined behavioral and pharmacologic treatment for obesity: Predictors of successful weight maintenance. (1998). Response of obese binge eaters to treatment by behavior therapy combined with very low calorie diet. Journal of Consulting and Clinical Psychology, 56(3), 399-4 4.Wadden, T.A., Foster, G.D., & Letizia, K.A. This may have been due, according to Goodrick, etal (1998), to the behavioral and cognitive components of the therapy.Conclusions Taken together, these articles suggest that binge eating behaviorsare most likely to be reduced through some type of cognitive-behavioraltherapy rather than by either exercise or diet therapies alone or intandem. Journal of Consulting and Clinical Psychology, 66(2), 363-368.Rodin, J., Elias, M., Silberstein, L.R., & Wagner, A. A survey of 232 members of Division 29 of theAmerican Psychological Association was undertaken, addressing assessmentand recommendation practices related to nutrition and exercise and physicalfitness. Rodin, Elias, Silberstein and Wagner (1988) examined behavioralinterventions for obesity reduction in combination with the use ofpharmacological therapy involving Tenuate (diethylpropion hydrochloride)treatment. Predictors of greater weight loss included: 1) greaterinitial weight loss; 2) agreement with the philosophy that a specified lowcalorie diet would not have helped foster weight loss; and 3) strongerfeelings along the Tenuate +CBT group in particular of self-efficacyregarding weight control. Episodicovereaters were more likely than subjects in the other two conditions todrop out during the final seven weeks of treatment, when participantsresumed the consumption of a conventional diet. (1994). (1992). Consequently, the researchquestion addressed in this brief report is: What interventions orstrategies are most useful in assisting obese female binge-eaters in firstcontrolling their binging behaviors and, second, losing weight as part of alifestyle change designed to improve physical and psychologicalfunctioning?Discussion A series of five articles from the literature speak to the foregoingresearch question. Nondieting versus dieting treatment for overweight binge-eating women. At six months post-treatment, the diet treatment group lost .6 kgwhereas the nondiet treatment group gained an average of 1.3 kg. Subjects participated in astructured protocol involving one week of a 1,2 calorie per day balanceddeficit diet followed by 12 weeks of a VLCD liquid diet providing 42 calories per day and a 12 week period in which subjects consumed only twoliters per day of noncaloric fluid.
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